Three-dimensional electroanatomical mapping to guide transseptal catheterization Mark R. Bowers, MS, MD, Padraig Gearoid O'Neill, MD, FHRS, Rohit Bhaskar,

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Date of download: 5/29/2016 Copyright © The American College of Cardiology. All rights reserved. From: Emerging Applications for Transseptal Left Heart.

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Presentation transcript:

Three-dimensional electroanatomical mapping to guide transseptal catheterization Mark R. Bowers, MS, MD, Padraig Gearoid O'Neill, MD, FHRS, Rohit Bhaskar, MD, Arash Aryana, MS, MD, FHRS HeartRhythm Case Reports Volume 4, Issue 6, Pages 219-221 (June 2018) DOI: 10.1016/j.hrcr.2018.01.001 Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 1 The 12-lead electrocardiogram of the clinical tachycardia illustrating an atypical left atrial flutter with positive P waves in leads V1 with 2:1 AV conduction. HeartRhythm Case Reports 2018 4, 219-221DOI: (10.1016/j.hrcr.2018.01.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 2 Visualizaton and correlation of the transseptal apparatus on three-dimensional (3-D) mapping and fluorsocopy. A: A 3-D electroanatomcial map of the right atrium, the superior vena cava (SVC), and the coronary sinus (CS) in the left anterior oblique projection delineating the left atrial cavity (LA) through extrapolation of geometry using the CS as its lateral boundary and the estimated general location of the fossa ovalis (purple arrow). The inset illustrates standard alligator clips conneted to a BRK-1 needle in turn connected to the 3-D mapping system to allow direct visualization of the needle tip/position to guide the transseptal puncture. Left (B) and right (C) anterior oblique fluoroscopic projections of the transseptal needle and site, illustrating the extreme eccentric posterior deviation of the transseptal apparatus with its tip and angle seemingly “pointing away” from the atrial septum. Additionally, an esophageal temperature probe can be seen on fluoroscopy. ICE = intracardiac echocardiography catheter; MV = mitral valve ring; TSS = transseptal; TV = tricuspid valve. HeartRhythm Case Reports 2018 4, 219-221DOI: (10.1016/j.hrcr.2018.01.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions

Figure 3 Visualizaton and correlation of the transseptal puncture on three-dimensional (3-D) mapping and fluorsocopy. Shown are 3-D electroanatomcial maps of the right atrium (RA), the superior vena cava (SVC), and the coronary sinus (CS) in the left anterior oblique (A) and posterior (B) projections delineating the left atrial cavity (LA) and the estimated general location of the fossa ovalis (FO). The final location of the FO was later confirmed by intracardiac echocardiography to be slightly more posterior to this location. A: A radiofrequency ablation catheter (ThermoCool SmartTouch, Biosense Webster, Inc, Diamond Bar, CA) crossing the atrial septum with geometry outlining the location of the transseptal sheath. B: A transseptal needle (SafeSept, Pressure Products, Charleston, WV) advanced into the LA crossing the FO, visualized directly inside the 3-D map. Additionally, an esophageal temperature probe can also be seen on fluoroscopy. ICE = intracardiac echocardiography catheter; MV = mitral valve ring; TSS = transseptal; TV = tricuspid valve. HeartRhythm Case Reports 2018 4, 219-221DOI: (10.1016/j.hrcr.2018.01.001) Copyright © 2018 Heart Rhythm Society Terms and Conditions